2.
Outline of Presentation <ul><li>Background on Study of Use of Auto-Enrollment for State Coverage Expansion </li></ul><ul><li>Overview of Massachusetts Health Reform </li></ul><ul><li>Findings – What Worked in Maximizing Enrollment </li></ul><ul><li>Lessons for National Health Reform Efforts </li></ul><ul><li>Conclusions </li></ul>

3.
Introduction <ul><li>Just two years after health reform enacted in Massachusetts, only 2.6 % of residents lacked health coverage </li></ul><ul><li>From 6/06 to 9/08, number of insured rose by 432,000 </li></ul><ul><li>56% of state’s increase in coverage occurred through Medicaid and CommonwealthCare </li></ul><ul><li>How did Massachusetts achieve such success? </li></ul>

4.
Overview of SHARE Study: Assessing the First Use of Auto-Enrollment for a State Coverage Expansion <ul><li>Focus on Massachusetts’ use of uncompensated care pool data to auto-enroll residents into CommCare </li></ul><ul><li>Will use CPS data, health plan encounter data, and state administrative data to analyze take-up rates, administrative cost savings, and utilization </li></ul><ul><li>Consumer focus groups and case study of implementation will support quantitative analyses </li></ul><ul><li>For case study: 2 day site visit (7/09), key informant interviews w/ policymakers, stakeholders, advocates </li></ul>

5.
Background on Health Reform in Massachusetts <ul><li>Subsidies to 300% FPL, thru Medicaid and new CommCare program </li></ul><ul><li>Individual mandate to purchase coverage (excluding those unable to afford, and children) </li></ul><ul><li>Enforced through state income tax system </li></ul><ul><li>Health insurance exchange (the “Connector”) links persons needing insurance w/ health plans </li></ul>

13.
Lowered State Administrative Costs <ul><li>Combined, policies lowered per capita admin costs of eligibility determination </li></ul><ul><li>UCP auto conversions much cheaper than if all had been required to apply </li></ul><ul><li>Applications submitted online cheaper than processing by hand </li></ul><ul><li>Errors substantially reduced by system “logic” </li></ul><ul><li>Single state eligibility agency also created efficiencies </li></ul><ul><li>Annual determinations doubled, but staff was only increased by 10 percent </li></ul>

14.
Some Challenges Remain <ul><li>Churning: Rates of disenrollment at renewal higher than desired; many return w/in months </li></ul><ul><li>Medicaid/CommCare transitions: Rules regarding start of coverage not aligned; can cause interruptions in coverage </li></ul><ul><li>Coverage for unemployed not included in system: One important program left out of integrated system </li></ul><ul><li>Some concerns about access: Issues of uneven access across state, and uneven utilization by “auto-converted” will be scrutinized in next components of study </li></ul>

16.
Lessons for National and State Health Care Reform <ul><li>Data-driven eligibility possible w/ federal tax forms </li></ul><ul><li>Single state agency could manage eligibility for Medicaid, CHIP, new subsidy programs </li></ul><ul><li>Single on-line application form for all programs could be designed </li></ul><ul><li>Grants to CBOs could support outreach & enrollment infrastructure </li></ul><ul><li>Extensive public education campaign builds awareness </li></ul>

17.
Conclusions <ul><li>Innovative administrative strategies essential to maximize enrollment, including: </li></ul><ul><li>- Using available data to establish eligibility (w/o filing new application) </li></ul><ul><li>- Applying for all available programs w/ single form </li></ul><ul><li>- Using integrated system for processing and putting people in correct programs </li></ul><ul><li>- Enlisting support from trained CBO/provider staff </li></ul><ul><li>- Conducting intensive public awareness campaign </li></ul>